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Proton‐pump inhibitor failure/resistance: Proposed mechanisms and therapeutic algorithm
Author(s) -
Cheung Ting K,
Wong Benjamin CY
Publication year - 2006
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2006.04716.x
Subject(s) - medicine , proton pump inhibitor , gerd , reflux , disease , intensive care medicine , esophageal sphincter , pathophysiology , bioinformatics , biology
Proton‐pump inhibitor (PPI) failure has become more prevalent with the increasing use of PPI as the first‐line agent in the treatment of gastroesophageal reflux disease (GERD). The underlying mechanisms are diverse and may overlap. The commonly available investigations are limited in their capacity in identifying the underlying cause for PPI failure. Multichannel intraluminal impedance with 24‐h pH sensors may be useful to identify non‐acid or duodenogastroesophageal reflux in selected cases. The management strategy for PPI failure is largely empirical. Patients who have symptomatic failure on normal dose of PPI shall try double dose PPI. Failing that, empirical treatment with transient lower esophageal sphincter relaxation reducers or pain modulators can be tried. Better understanding of the pathophysiology and mechanisms for PPI failure will help to improve the management of this rising problem.